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level: Level 1

Questions and Answers List

level questions: Level 1

QuestionAnswer
What are some risk factors of UTIsAge Female Catheters Pregnancy Diabetes Immunocompromised Shorter urethra Sexual activity
How do bacteria enter the Urinary TractRetrograde → ascending infection from the urethra Via blood/lymphatics Direct → catheter, surgery , instrumentation
What are some bacterial virulence factors involved in infection of the UTAdhesion – fimbriae and adhesins allow attachment to uroepithelium K antigens – capsule resistant to phagocytosis
What are some bacteria that cause uncomplicated UTIsE.coli , Staphylococcus saprophyticus
What are some natural defencesLow pH, high concentration of urea Regular flushing – removes bacteria from distal urethra Mucin layer Antibacterial secretions by urothelium into the mucin layer Inflammation & exfoliation of cells
What are some common presentationsDysuria Frequency / Urgency Haematuria Incontinence Cloudy/Offensive smelling urine Pain
What is urethral syndromeAbout 50% of women who present with the clinical features of cystitis do not have positive urine cultures, a ‘urethral syndrome’ It could be an infection with low counts of bacteria STIs Non-infective inflammation e.g. chemical Infection with fastidious organisms not detected on routine culture
What does urine dipstick look forNitrites --> Nitrite produced by bacterial nitrate reductase when bacteria in contact with urine Leucocytes
What are some treatments for UTIsUncomplicated lower UTIs --> Short course of ABx (women 3 days, men 7 days) or delay and Nitrofurantoin (check eGFR) or Trimethoprim first line Supportive measures --> fluids etc. Always safety net Guided by results of culture
What is asymptomatic bacteruriaCommon in elderly Unless patient has symptoms , dont treat --> also if pregnant then treat Does not reduce morbidity/mortality Can lead to increase in antibiotic resistance
What is the difference between reinfection and relapseReinfection --> Infection within 14 days but can be any organism while relapse is within 7 days and is the same organism Relapse can be due to failure of treatment
Difference between complicated and uncomplicated UTIsComplicated: UTI with an increased likelihood of complications such as persistent infection, treatment failure and recurrent infection Uncomplicated: UTI caused by typical pathogens in people with a normal urinary tract and kidney function, and no predisposing co-morbidities
What are the different ways of taking urine culturesMid-stream Urine (MSU) sample preferred Catheter technique Pad sample
When do you order a urine cultureOnly if there is higher risk of complications e.g. Pregnancy Suspected pyelonephritis Suspected UTI in men Failed antibiotic treatment or recurrent symptoms Recurrent UTI It is not used routinely in uncomplicated UTIs
What is treatment for UTIsFor uncomplicated lower UTIs then short course of antibiotics ( 3 days for women and 7 days for men ) Supportive measures Guided by results of culture